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Strabismus and squint
- 1. Strabismus and squint DNYANESHWARB. POTFODE OPHTHALMIC OFFICER
- 2. Extraocular muscles • Medialrectus : 5.5 mm • Inferior rectus : 6.5 mm • Lateral rectus : 6. 9 mm • Superior rectus : 7.7 mm • superior oblique muscle • inferior oblique muscle
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- 4. Origin of therectus muscles and the superior oblique muscle
- 5. Nerve supply • Oculomotor-superior, medial, inferior recti and inferior oblique muscles. • Trochlear- Superior oblique • Abducent- Lateral rectus muscle.
- 6. Action of theextraocular muscles
- 7. Action of theextraocular muscles
- 8. OCULAR MOTILITY • Uniocularmovements- ‘ductions’ • Binocular movements- versions vergences.
- 9. Uniocular movements- ‘ductions’ •1. Adduction • 2. Abduction • 3. Supraduction. • 4. Infraduction • 5. Incycloduction • 6. Excycloduction
- 10. Binocular movements- Versions •1. Dextroversion • 2. Levoversion. • 3. Supraversion • 4. Infraversion • 5. Dextrocycloversion. • 6. Levocycloversion
- 11. Binocular movements- Vergences •1. Convergence • 2. Divergence
- 13. BINOCULAR SINGLE VISION •Grades of binocular single vision • Grade I — Simultaneous perception • Grade II— Fusion. • Grade III— Stereopsis.
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- 17. Anomalies of binocularvision Suppression, Amblyopia Abnormal retinal correspondence (ARC), Confusion Diplopia.
- 18. STRABISMUS • A misalignmentof the visual axes of the two eyes is called squint or strabismus.
- 19. Classification of strabismus •I. Apparent squint or pseudostrabismus. • II. Latent squint (Heterophoria) • III. Manifest squint (Heterotropia) 1. Concomitant squint 2. Incomitant squint.
- 20. HETEROPHORIA •Heterophoria also knownas ‘latent strabismus’, is a condition in which the tendency of the eyes to deviate is kept latent by fusion.
- 21. Types of heterophoria •1. Esophoria • i Convergence • ii Divergence • 2. Exophoria • 3. Hyperphoria • 4. Cyclophoria
- 22. Etiology 1. Orbital asymmetry. 2.Abnormal interpupillary distance (IPD) 3. Faulty insertion of extraocular muscle. 4. A mild degree of extraocular muscleweakness. 5. Anomalous central distribution ofthe tonic innervation of the two eyes 6. Anatomical variation in he position of the macula
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- 25. Symptoms • 1. Symptomsof muscular fatigue. • 2. Symptoms of failure to maintain binocular single • 3. Symptoms of defective postural sensations cause
- 26. Examination of acase of heterophoria • 1. Testing for vision and refractive error • 2. Cover-uncover test. • 3. Prism cover test • 4. Maddox rod test • 5. Maddox wing test. • 6. Measurement of convergence and accommodation • 7. Measurement of fusional reserve
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- 30. Treatment • 1. Correctionof refractive error • 2. Orthoptic treatment • 3. Prescription of prism in glasses • 4. Surgical treatment
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- 32. Etiology • Refractive errors, •Prolonged use of incorrect spectacles, • Anisometropia, • Corneal opacities, • Lenticular opacities, • Diseases of macula (e.g., central chorioretinitis), • Optic atrophy, and • Obstruction in the pupillary area due to congenital ptosis.
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- 35. EVALUATION OF ACASE OF CONCOMITANT STRABISMUS • I. History • II. Examination • 1. Inspection • 2. Ocular movements. • 3. Pupillary reactions • 4. Media and fundus examination. • 5. Testing of vision and refractive error • 6. Cover tests • i. Direct cover test • ii. Alternate cover test • 7. Estimation of angle of deviation • i. Hirschberg corneal reflex test • ii. The prism and cover test • iii. Krimsky corneal reflex test.
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- 38. TREATMENT • 1. Spectacleswith full correction of refractive error • 2. Occlusion therapy • 3. Preoperative orthoptic exercises • 4. Squint surgery
- 39. Surgical techniques • 1.Muscle weakening procedures • 2. Muscle strengthening procedures • 3. Procedures that change direction of muscle action
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